The Affordable Care Act

The Affordable Care Act – What Does It Mean for Me, My Practice and My Patients?

We know the Affordable Care Act (ACA) and all the Implications are confusing for everyone. The MDA is making an effort to pass along information to dentists and how the ACA is effecting them as well as their practice and their patients. The reality is that questions will remain, and details will continue to develop, so please be on the look-out for further information. What information we have currently, is found below:

What is the Affordable Care Act (ACA)?
The Patient Protection and Affordable Care Act (PPACA), commonly called the Affordable Care Act (ACA) or "Obamacare", is a United States federal statute signed into law by President Obama on March 23, 2010. The ACA was enacted with the goals of increasing the quality and affordability of health insurance, lowering the uninsured rate by expanding public and private insurance coverage, and reducing the costs of healthcare for individuals and the government. You may reference the ACA at this website: https://www.healthcare.gov/where-can-i-read-the-affordable-care-act/

What does the ACA do?
It introduces a number of mechanisms—including mandates, subsidies, and insurance exchanges—meant to increase insurance coverage and affordability. The law also requires insurance companies to cover all applicants within new minimum standards and offer the same rates regardless of pre-existing conditions or sex. These additional reforms are aimed to reduce costs and improve healthcare outcomes by shifting the system towards quality over quantity through increased competition, regulation, and incentives to streamline the delivery of healthcare. The projected goal is that the ACA will lower both future deficits and Medicare spending. Among other things, the most important feature is the requirement that (almost) all Americans must have a minimum amount of health insurance or be assessed a financial penalty.

What does “almost” all Americans mean? Among the exempted groups are members of a religion that opposes health insurance, undocumented immigrants, incarcerated individuals, members of Indian tribes, those earning so little that they are not required to file a tax return and those unable to find insurance that costs less than 8% of their income.

What if I have been unable to qualify for insurance in the past because of a serious medical condition? The law requires all health insurance to be on a “guaranteed issue” basis, meaning no denial or premium rating based on current health status or previous history. Moving from one insurance carrier to another should also be easier under this law.
How is the required insurance purchased? Individuals who are not covered by some type of government program (such as Medicare) will have four choices:
• Get coverage through their employer’s group plan.
• Buy a plan on their own through the traditional insurance market (agent, broker,
direct from insurance carrier).
• Buy a plan through a government-organized insurance “exchange.”
• Remain uninsured, pay their own health care bills and pay the financial penalty to the
government.

What is an exchange?
The law requires each state to set up their own health benefit exchange (or health insurance marketplaces as described by regulators) or to participate in the federally run exchange. Individuals and small employers can compare and buy health insurance telephonically or online through this mechanism. These exchanges do not replace buying health insurance through the traditional sources, but are simply a new, additional way to shop and buy. Plan designs and premiums will vary by state.
Even though many problems have been reported, the federal and state exchanges began enrolling beneficiaries on October 1st and are supposed to be fully operational by January 1, 2014.

What type of exchange do we have in Mississippi?
As you may recall, initially Mississippi planned to establish and provide a state exchange. However after considerable research, work and the development of a proposal that was submitted to Washington, our application for a Mississippi run exchange was denied by the federal government and now our state is a participant in the federally run exchange. The federally run exchange for Mississippi may be accessed at https://www.healthcare.gov/ .

Is there financial assistance for individuals purchasing their individual coverage?
Individuals with limited financial means may be able to qualify for assistance. In order to qualify, they must purchase their health insurance through an exchange. Those with incomes from 100-400% of the federal poverty level (FPL) are eligible to receive tax credits to subsidize their coverage through the exchange.

How do these subsidies work for individuals and small businesses? Individuals who earn up to $45,960 a year may qualify for subsidies to help cover their monthly health insurance payments. Families may also be eligible depending on income and family size. For more information: https://www.healthcare.gov/how-can-i-save-money-on-marketplace-coverage/. Small business employers who pay at least 50 % of the premium for employee coverage may qualify for a small business tax credit. To qualify, the employer must have less than 25 full-time employees whose average annual per-employee wage does not exceed $50,000. The tax credits, which are supposed to go away after 2016, will be available on a sliding scale to assist with the purchase of health insurance. Dentists are encouraged to consult with their tax advisors or CPAs about these credits. More information can be referenced at: https://www.healthcare.gov/will-i-qualify-for-small-business-health-care-tax-credits/

Isn’t an employer required to offer a group health insurance plan?
No, only employers with 50 or more full-time employees are required to offer an ‘affordable” plan to their employees (not family members). But such an employer may instead opt to pay a government financial penalty, leaving their employees to buy their own. Furthermore, it was recently announced by the federal administration that the requirement for employers with 50 or more full-time employees will not be required to offer health insurance until 2015.

What are dentists as small business employers required to offer?
Dentists and allied personnel have particular concerns with this law as they are most commonly small employers (99% of dental practices have less than 50 employees) or employees of small employers. Employers with 49 full-time employees or fewer are not required to offer health insurance, but may voluntarily do so. Employers with 25 or fewer full-time employees may even receive tax credits to help pay for health insurance.

What are the tax penalties for individuals and small businesses that do not sign up for health insurance? The federal government has established the following penalties for individuals:
• 2014 - $95 or 1% of income, whichever is greater;
• 2015 - $325 or 2% of income, whichever is greater; and
• 2016 - $695 or 2.5% of income, whichever is greater. (Exemptions may apply for certain individuals below a certain, income level who cannot afford available coverage.)
Penalties for small businesses:
• Business owners with up to 50 FTE employees that do not offer health insurance will NOT have to pay a penalty, and
• Business owners with more than 50 FTE employees that do not offer health insurance may be subject to penalties starting in 2014

Is dental insurance coverage required under the Affordable Care Act (ACA)?
Yes, for children but not adults. After January 1, 2014, all individual and small group market plans – both inside and outside the exchange – must be certified as "qualified health plans" except for stand-alone dental plans. QHPs must provide all "essential health benefits". Pediatric oral health services are included in the 10-category EHB package and must be offered.

How are dentists as health care consumers affected?
Plans in the individual and small group market are prohibited from imposing pre-existing condition limitations, excessive waiting periods and copayments or deductibles for certain preventive services. Coverage must be guaranteed issue and provide for guaranteed renewability and plans are prohibited from rescinding coverage. Plans may use age, tobacco use, where someone lives and family composition to calculate premiums and must offer coverage for dependents up to age 26.
How will the MDA’s Group Health Insurance Program be impacted? For over 20 years, the MDA has provided an endorsed health insurance program. We expect this member benefit to continue under the new law, offering quality, competitive health insurance to its members. We strongly encourage all of our member dentists to contact Brown and Brown / Robert Ellis & Associates to conduct an evaluation of your current plan to see and to compare any additional options. By doing so, you will be able to make the best informed decisions for your health insurance needs. You may contact Stormy or Donna at 1-888-503-5547.

Where can I get more information?
The Mississippi Insurance Department is able to assist: http://www.mid.ms.gov/pages/health_care_reform.aspx .

Have more questions about the Affordable Care Act? Read the ADA FAQs.

The ADA put together a series of articles that examines the Affordable Care Act and oral health. Below you will find the ADA's analysis of impact of the Affordable Care Act.

The
Affordable Care Act (ACA) amended the Fair Labor Standards Act by
creating a requirement that employers provide a notice (aka exchange
notice) to employees informing them of the existence of the newly formed
ACA marketplaces along with information on how to contact the
marketplace to request assistance in purchasing coverage if employees
choose to do so. The state and federal insurance exchanges are simply
websites where individuals and small businesses can shop for insurance.

Specifically,
by October 1, 2013 all employers covered by the Fair Labor Standards
Act (which includes dental offices with employees) should furnish each
employee with a notice that informs the employee that there are new
health insurance marketplace coverage options available.

Employers
should keep a copy of the form that has been signed and dated by the
employee for future reference. This notice is only required to each
current or new employee one time.

It is important to note that
the requirement has no effect on whether an employer offers health care
coverage to their employees; however, businesses with fewer than 25
employees that do provide health care coverage may be eligible for tax
credits. More information on the small business tax credits can be found
at irs.gov.

Mississippi does not have a state-supported Health
Insurance Exchange at this time. Information about the availability of
plans can be found at www.HealthCare.govEmployee / Patient Information

Requires states to have temporary high-risk pools or mechanism for uninsured people with pre-existing conditions.

September 2010

Prohibits insurers from rescinding coverage after a sickness, imposing life time caps, and denying coverage to children with pre-existing conditions

Allows parents to keep children on their policies until age 16.

2011

Requires medical loss ratios of 80 and 85%, respectively, for individual/small group and large group plans.

Begins a voluntary Long Term Care (LTC) program financed through payroll deductions.

2012

Imposes a new annual fee on drug manufacturers.

2013

Raises the Medicare payroll tax for high-income workers and imposes a new tax on medical device sales

2014

Requires states to implement insurance exchanges for individual/small business markets (federal funding to states is available from 3/2011 to 1/1/2015).

Prohibits insurers from denying coverage based on pre-existing conditions and imposes a new annual fee on health insurers.

Imposes a mandate that individuals acquire health insurance coverage of pay, by 2016, the greater of $695 or 2.5 percent of income

Imposes mandates on employers with 50+ workers: offer coverage or by 2014 pay $2000/ft worker (excluding the first 30); ifoffer unaffordable coverage, pay $3000/employee receiving taxpayer assistance to buy it or a total of $2000/employee, whichever is more (employers of 50 or fewer workers are exempt).

Expands Medicaid to those making under 133 percent of the Federal Poverty level